Provider Demographics
NPI:1144428574
Name:SURPRISE, KIRBY GILBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:GILBERT
Last Name:SURPRISE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1002
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:1250 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1002
Practice Address - Country:US
Practice Address - Phone:510-655-7880
Practice Address - Fax:510-655-3379
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2007065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical